SR0080158 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT / CALL 2`09)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED •JOB ADDRESS C lnz e-G G � CITY/ZIP (1,, �✓ :4 �S Z1 v CROSS STREET APN PARCEL SIZE 1 p d OWNER NAME ^I PHONE 2U�-�(✓I �3Z l v� 11 �7 14 ( f / Gj OWNER ADDRESS T I T C lilC�© lc-e- <24 CITY/STATE/ZIP lG�p rt CA CONTRACTOR se PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I I C-42 I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y I J PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION I I REPAIR/ADDITION I I ENGINEER DESI ED/ALTERNATI E REPLACEMENT 1 1 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE I I COMMERCIAL FI OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: I&I SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LI LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH IVT ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN r� ft E3 SUMPS WIDTH ft LENGTH ft DEPTH e C7 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTIP61ft 13DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH tjFNvi U/ry c ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN H 6FA,`NTALL ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH MENT ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. M 8 oug AbViNCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE Oc.Jj/V lZr DATE Z— — /7 EPA R TMENTAJSEIONL Y IL 1 4w Application Accepted By Date Area Employee ID 1 Final Inspection Byffi-p— Date C! SPECIAL PERMIT-Approved by Character of Soil to D th of 3 Ft: PiVS mp Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/Code INFO B Cash Remedit Date Service Request# Invoice# Permit ID# 2Z 5 42-01 ( ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17